目的 探讨附桂骨痛胶囊联合来氟米特治疗类风湿关节炎的临床疗效。方法 选取2017年8月—2019年12月上海交通大学医学院附属第九人民医院北部90例类风湿关节炎患者作为研究对象，按照治疗方法分为对照组和观察组，每组各45例。对照组口服来氟米特片，10 mg/次，1次/d。观察组在对照组治疗的基础上口服附桂骨痛胶囊，4粒/次，3次/d。两组连续治疗3个月。对比两组的临床总有效率，比较两组关节肿胀数、压痛数、晨僵时间的变化。检测患者治疗前后血清C反应蛋白（CRP）、白细胞介素-32（IL-32）、类风湿因子（RF）、血沉的水平及血液流变学指标。记录药物不良反应的发生情况。结果 治疗后，观察组患者总有效率为95.56%，对照组为82.22%，两组间比较差异有统计学意义（P<0.05）。治疗后，两组关节肿胀数、压痛数、晨僵时间显著降低（P<0.05），以观察组降低更明显（P<0.05）。治疗后，两组的CRP、IL-32、RF、血沉水平均显著降低（P<0.05）；治疗后，观察组的CRP、IL-32、RF、血沉水平显著低于对照组，差异有统计学意义（P<0.05）。治疗后，两组的全血黏度、血浆比黏度、红细胞压积、血小板聚集率均显著降低（P<0.05）；治疗后，观察组的全血黏度、血浆比黏度、红细胞压积、血小板聚集率显著低于对照组，差异有统计学意义（P<0.05）。两组药物不良反应的发生率无明显差异。结论 附桂骨痛胶囊联合来氟米特片治疗类风湿关节炎的疗效确切，可降低炎症反应，改善血液流变学水平，显著改善临床症状。

Objective To investigate the clinical efficacy of Fugui Gutong Capsules combined with leflunomide in treatment of rheumatoid arthritis. Methods Ninety patients with rheumatoid arthritis from August 2017 to December 2019 in the Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine were selected as the research subjects, and were divided into control group and observation group according to treatment methods, with 45 cases in each group. Patients in the control group were po administered with Leflunomide Tablets, 10 mg/time, once daily. Patients in the observation group were po administered with Fugui Gutong Capsules on the basis of control group, 4 capsules/time, three times daily. The two groups were treated for 3 months. The clinical total effective rate of two groups was compared, and the changes of joint swelling number, tenderness number, and morning stiffness time were compared. Serum levels of C-reactive protein (CRP), interleukin-32 (IL-32), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and hemorheology were detected before and after treatment. Record the occurrence of adverse drug reactions. Results After treatment, the total effective rate was 95.56% in the observation group and 82.22% in the control group, and the difference between two groups was statistically significant (P < 0.05). After treatment, joint swelling number, tenderness number, and morning stiff time in two groups were significantly decreased (P < 0.05), and the decrease was more obvious in the observation group (P < 0.05). After treatment, the levels of CRP, IL-32, RF, and erythrocyte sedimentation rate in two groups were significantly decreased (P < 0.05). After treatment, the levels of CRP, IL-32, RF, and erythrocyte sedimentation rate in the observation group were significantly lower than those in the control group, with statistical significance (P < 0.05). After treatment, the whole blood viscosity, plasma specific viscosity, hematocrit, and platelet aggregation rate in two groups were significantly decreased (P < 0.05). After treatment, the whole blood viscosity, plasma specific viscosity, hematocrit, and platelet aggregation rate in the observation group were significantly lower than those in the control group, with statistical significance (P < 0.05). There was no significant difference in the incidence of adverse drug reactions between two groups. Conclusion Fugui Gutong Capsules combined with Leflunomide Tablets has definite curative effect in treatment of rheumatoid arthritis, which can reduce inflammatory response, improve hemorheology level and significantly improve clinical symptoms.

R979.5

上海市科研计划项目（19ZR1429200）